MEDICARE: ISELEN BUSINESS ENTERPRISE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	253Z00000X	OTHER	CA	IN HOME SUPPORTIVE CARE

General Provider Information

NPI Number	:	1356809594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISELEN BUSINESS ENTERPRISE, INC

Provider Business Mailing Address
First Line	:	3137 CASTRO VALLEY BLVD STE 201
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5552
Country	:	US
Telephone Number	:	510-690-9612
Fax Number	:	510-690-9652

Provider Business Practice Location Address
First Line	:	3137 CASTRO VALLEY BLVD STE 201
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5552
Country	:	US
Telephone Number	:	510-690-9612
Fax Number	:	510-690-9652

Authorized Official
Title or Position	:	OWNER
Name	:	RONKE ISELEN
Credential	:
Telephone Number	:	510-690-9612

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/06/2019

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Directions to “ISELEN BUSINESS ENTERPRISE, INC ” Practice Location

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